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General NPI Number Information
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NPI Number | 1013259563
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Entity Type | Organization
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Legal Business Name | ALFREDO S. SISON JR MD LLC
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Dates
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Enumeration Date | 03/22/2013
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Last Update Date | 03/22/2013
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Provider Practice Location Address
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Address Line | 110 N ROBINSON ST STE 200
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City | RICHMOND
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State | VA
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Zip | 23220-4460
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Country | US
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Telephone | 804-379-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 2601 RADNOR PL
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City | MIDLOTHIAN
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State | VA
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Zip | 23113-6496
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Country | US
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Telephone | 804-379-2000
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DR. ALFREDO S SISON JR.
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Credential | MD
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Telephone | 804-379-2000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 0101058391
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License Number State | VA
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